Impact of Labor Analgesia on Delivery Outcomes in Parturients With Gestational Diabetes Mellitus

Although the efficacy of labor analgesia in pain relief is well-established, its impact on labor progression and maternal-neonatal outcomes remains inconclusive, particularly in parturients with gestational diabetes mellitus (GDM). This study aimed to examine the effects of labor analgesia on labor progression, delivery mode, and neonatal outcomes in parturients with GDM, thereby providing evidence to optimize clinical intervention strategies.

A total of 201 GDM parturients meeting inclusion criteria at Beilun District People's Hospital of Ningbo City between 1 January 2023 and 31 December 2024, were retrospectively analyzed. Participants were allocated to the observation group (labor analgesia, n = 111) or the control group (routine delivery, n = 90) based on whether they received labor analgesia. Maternal clinical data, delivery mode, labor duration, maximum intrapartum temperature, postpartum hemorrhage, neonatal Apgar scores, and other obstetric outcomes were compared and analyzed retrospectively. Statistical analyses included independent sample t-tests, Mann-Whitney U test, Chi-squared tests, and Chi-squared correction.

Among the 111 parturients receiving labor analgesia, the 2-hour capillary blood glucose variation during labor was significantly higher in the epidural analgesia (EP) group compared with the combined spinal-epidural analgesia (CSEA) group (p < 0.001). The postpartum fasting plasma glucose (FPG) difference was also significantly greater (p < 0.001). The numerical rating scale (NRS) score after EP in the observation group was markedly lower than the pre-analgesia score (p < 0.001). The observation group demonstrated longer first and second stages of labor (p < 0.05), lower 2-hourly glucose fluctuations, higher maximum intrapartum temperature (p < 0.05) and soft tissue lacerations (p < 0.05), and increased rates of oxytocin use and episiotomy (p < 0.05). Furthermore, urinary ketone positivity, FPG difference, and 2-hour postprandial blood glucose (2hPBG) difference were lower in the observation group (p < 0.05), whereas postpartum day 1 C-reactive protein (CRP) levels were higher (p < 0.05). No significant differences were observed in delivery mode, postpartum urinary retention, postpartum hemorrhage, neonatal clavicle fracture, neonatal transfer, or incidence of patent foramen ovale and ductus arteriosus (p > 0.05).

Labor analgesia effectively alleviates labor pain and stabilizes intrapartum blood glucose fluctuations without increasing the risk of cesarean delivery or adverse maternal-neonatal outcomes. However, it may prolong labor duration, elevate intrapartum temperature, and increase oxytocin use, as well as the rates of episiotomy and soft birth canal lacerations. For GDM parturients receiving labor analgesia, close monitoring and management of blood glucose, uterine contractions, and labor progression are essential to minimize potential risks associated with vaginal delivery.